Categories
Hospitalizations Leading Cause of Death Long-term effects National changes

Infodemic

In February 2020, the WHO reported that we’re not only fighting COVID-19, but also an infodemic. “An overabundance of information—some accurate and some not—that makes it hard for people to find trustworthy sources and reliable guidance when they need it.” Information overload.

Which can (and does) cause anxiety, even if the information is true. The problem is if people get the wrong information from unreliable sources we are going to have a hard time stopping this virus. And we are in the United States.

In fact, scientists just published an article showing how the infodemic (and specifically misinformation) has impacted mortality, public health interventions, and treatment. They examined rumors, stigma and conspiracy theories circulating on social media between December-April 2020.

What did they find?
• Misinformation was present in 87 countries and 25 languages
• Of this misinformation, 89% were rumors, 8% were conspiracy theories, and 4% were stigma
• 24% of claims had to do with transmission and mortality; 21% public health interventions; 19% treatment and cure; 15% origin of the disease
• Countries with the highest rate of misinformation (in order): India; United States; China; Spain; UK

Their conclusions?
• Misinformation can have severe implications on public health if prioritized over science
• “Health agencies must track misinformation associated with COVID19 in real-time, and engage stakeholders to debunk misinformation”

Love, your local epidemiologist

Data Source: Islam et al., (2020) COVID19 related infodemic and its impact on public health: A global social media analysis. Am. J. Top. Med. Hyg. 

Categories
Long-term effects National changes Social Distancing

Pitting public health against economic health

Pitting public health against economic health through a simple trade-off (saving lives vs. saving the economy) is unhelpful and simply not accurate.

Something that gets lost in public conversation is how interdependent the two are. Health systems know that financial health is a critical part of people’s well-being. On the flip side, the financial community knows that having healthy workers and families is vital for productivity and viability. It’s just time to get the public (and policy makers) to understand the interdependence.

A study was just published that asked: Do nationwide shut-downs negatively impact the economy? Scientists compared spending patterns (bank records of more than 800,000 people) in Denmark (who had strict shut-down) compared to spending patterns in Sweden (who didn’t have a lock down). And yes, they compared spending patterns AFTER taking into account things like stock market indexes, unemployment claims, cross-country spending, time of year, etc., etc..

What did they find?

  • There was only a 4% difference in spending between the two countries (Denmark saw a 29% drop in spending; and Sweden saw a 25% drop in spending) after the pandemic was declared
  • There was a bigger drop in spending among 18-29 years olds in Denmark compared to Sweden. In other words, a shutdown constrains the young, who in the absence of a shutdown, would contribute the most to spreading the disease
  • There was a bigger drop in spending among 70+ year olds in Sweden compared to Denmark. In other words, a shutdown contained the spread of the disease and reduce the need for extreme isolation among the most at risk (and reduced mortality).  
Sheridan et al. (Aug 2020). Social Distancing Laws Cause Only Small Losses of Economic Activity during the COVID-19 Pandemic in Scandinavia. Proceedings of the National Academy of Sciences of the United States of America. https://doi.org/10.1073/pnas.2010068117
Sheridan et al. (Aug 2020). Social Distancing Laws Cause Only Small Losses of Economic Activity during the COVID-19 Pandemic in Scandinavia. Proceedings of the National Academy of Sciences of the United States of America. https://doi.org/10.1073/pnas.2010068117

Translation? Social distancing laws only cause small losses in the economy while having major benefits on morbidity and mortality. Instead, the virus itself causes economic turmoil (people cut back on consumption, cut back on work due to personal health risks, social norms, or a sense of civic duty). By reducing the spread of disease quickly (through shut downs in this case), more people will be comfortable with going outside, spending money, and working.

How does this apply to other countries? The authors comment on this too. Unfortunately, in the US, we have three things going against us:

  1. Our national “strategy” is a long, drawn out, uncoordinated response
  2. Lack of social insurance policies
  3. A diverse range of civic and social responsibility

The authors state, “A combination of these factors may correlate with reductions in economic activity and, hence, results in the impact of government-mandated shutdowns.”

Love, your local epidemiologist

Data Source: Sheridan et al. (Aug 2020). Social Distancing Laws Cause Only Small Losses of Economic Activity during the COVID-19 Pandemic in Scandinavia. Proceedings of the National Academy of Sciences of the United States of America. https://doi.org/10.1073/pnas.2010068117

Categories
Innovative Solutions National changes Social Distancing

Election Season

Election season is upon us! Milwaukee was the first to hold an in-person election during the COVID19 pandemic. Scientists just (July 31) published a case study on COVID19 spread at this Milwaukee election.

What happened?
March 3: CDC published health and safety guidelines for state elections
March 13: 1st ever COVID19 case popped up in Milwaukee
March 25: Stay-at-home statewide policy implemented in Wisconsin
April 7: Election day
April 9-21: Incubation period (that is, IF people were infected at the polls, this is when their symptoms would start). 
May 5: Marks 4 weeks after the elections (i.e. that is, IF people were infected at the polls, this is when we should see deaths by)

What did they find?
• Cases did not increase after the election. Of the COVID19 infections seen throughout Milwaukee, 28% occurred BEFORE the election and 21% occurred AFTER the election (within the incubation period). 
• Deaths did not increase after the election. Of the COVID19 deaths seen throughout Milwaukee, there were 36 deaths pre-election compared to 24 deaths post-election (within the lagged death timeline)
• Hospitalizations also did not increase post-election compared to pre-election

So….what?
Milwaukee made key changes to mitigate COVID19 spread during their election:
• Public messaging campaigns to limit in-person voting (people who voted by absentee mail-in ballots in Milwaukee increased from 4% in 2016 to 68% in 2020; Voting while remaining in vehicle increased in Milwaukee from 4.7% in 2016 to 12.2% in 2020)
• Polling site safety (employing PPE and environmental cleaning to lower transmission risk at in-person polls)
• CDC also recommends: longer voting periods, and other options such as increasing the number of polling locations to reduce the number of voters who congregate indoors in polling locations

All cities can learn from this case study. We can still have an election season while mitigating COVID19 spread and, thus, medically benefit the community. 

Love, your local epidemiologist

Data Source: Figure by me. 
Data from: Paradis H, Katrichis J, Stevenson M, et al. Notes from the Field: Public Health Efforts to Mitigate COVID-19 Transmission During the April 7, 2020, Election ― City of Milwaukee, Wisconsin, March 13–May 5, 2020. MMWR Morb Mortal Wkly Rep 2020;69:1002–1003. 

Categories
Deaths Hospitalizations National changes Testing

July

Well, July wasn’t pretty…either.

In order to get the best comprehensive picture, I triangulated several constructs:

Cases (i.e. incidence): In the month of July, 23 states jumped to a higher CDC COVID19 risk category. For example, OK jumped from orange (13.7 daily cases per 100,000) to red (26.8 daily cases per 100,000). Shout out to VT…the only state that got better (jumped from yellow to green). VT is the first state to make it to the green risk category.

Deaths: Because of increased incidence, cumulative and daily deaths have increased in July for the majority of states. The figure includes daily deaths July 31 compared to July 1. NJ is looking good! CFR or IFR are incredibly difficult to estimate (and take a lot of time), so I didn’t include. See earlier posts: https://yourlocalepidemiologist.com/case-fatality-rates/; https://yourlocalepidemiologist.com/case-fatality-rates-2/).

Testing (i.e. test positivity rate [TPR]): 41 states look like they have testing under control (under 10% TPR). Although we really need to get this to below 5%. There are 10 states that need some serious help (over 10% TPR). We are looking at you AL, AZ, FL, GA, ID, LA, NE, SC, TX, and VA.

Hospitalizations: Not even going to try to compare July 31 to July 1 because of the data reporting switch. But hospitalizations did increase in July. We know this because incidence and deaths increase.

The good news is that it LOOKS like some states may have recently (like past two days) reached their peak. If you live in one of these states, DO NOT CHANGE A DARN THING. We need to be well down the curve to start opening strategically and changing individual behaviors.

Maybe August will be our month?? Here’s the BEST peer-reviewed scientific article of how to get out of this mess by October.

Love, your local epidemiologist

Data sources: Analysis and graphs (except the first one) by yours truly. Data came from many sources: COVID19 tracking project, Harvard , and CDC.

Categories
National changes

The decision to bypass the CDC for data reporting…

Many are asking for my opinion. I try very hard to only provide data-driven information on this page (keep politics and my opinion out). I’m a part of a large, professional group and, in the past 24 hours, epidemiologists are continuing to share “what happened”, “pros” and “cons”. I have summarized epidemiologists’ thoughts thus far. So this is a qualitative data-driven update…

What happened?
The new data reporting pipeline has been under development for some time now. Due to the “official” change yesterday, data will now be fed into the Department of Human and Health Services wide electronic data management system. The CDC, as a part of HHS, will still have access to this data. But now, other HHS departments will have direct access to the data. The data will be managed by a large contracting company that many epidemiologists trust. The White House does not have direct access to the raw data.

Pros?
This will free up CDC to focus on tasks like data analysis and reporting. It MAY improve data quality. Having a central repository for this information, or a streamlined reporting system, helps minimize the burden associated with hospitals reporting these data.

Cons?
Epidemiologists are worrying about the availability of data to the general public (like excess mortality that I posted today). It may NOT improve data quality, and actually make it worse. Getting hospitals and agencies to switch from their existing reporting system to a new one can be a nightmare for data consistency.

There is a legitimate concern of politicizing science. Many epidemiologists are wondering “why now” and we haven’t found the answer yet. I’ll let you know if we are successful. But, nonetheless, only time will reflect the true motivations behind this change and whether pros outweigh the cons.

Love, your local epidemiologist

Categories
Children Daycare National changes

AAP statement

A follow-up to my post last week RE: COVID19 and kids, as the American Academy of Pediatrics (AAP) made a splash this week.

Some background… The AAP is a professional group made up of 66,000 pediatricians across the nation. They remain the golden standard of data-driven recommendations. They have laid the foundation for childhood safety and health throughout the years.

The AAP published a report advocating “that all policy considerations for the coming school year should start with a goal of having students physically present in school.” This INCLUDES children with special medical needs.

They make the argument that the benefits of childhood development outweigh the risks: “Schools are fundamental to child and adolescent development and well-being and provide our children and adolescents with academic instruction, social and emotional skills, safety, reliable nutrition, physical/speech and mental health therapy, and opportunities for physical activity, among other benefits. Beyond supporting the educational development of children and adolescents, schools play a critical role in addressing racial and social inequity.”

Their policy is long, but readable (i.e. not science-y) and have some innovative solutions. Here is the link: https://services.aap.org/…/covid-19-planning-consideration…/

This may be useful, again, to our parents, teachers, and administrators who have been working tirelessly to address the needs of children through this unprecedented time.

I recognize there are many angles to this decision. Including the health of teachers and staff. Although this is a pediatric institution, they do include a large section regarding the health (physical and mental) and safety of staff/teachers.

Love, your local epidemiologist

P.S. If you would like to see the science of COVID19 spread among children, see my post from June 19. For some reason, I cannot reshare. There are some fantastic studies in there regarding kid-to-kid and kid-to-adult transmission.

Categories
Innovative Solutions National changes Social Distancing

COVID19 National Policies

Because this was the first pandemic in modern time, the shutdowns were unprecedented. No one knew the potential financial, social, and medical impact. The financial costs of the shutdowns were obvious- closed restaurants, job furloughs, job loss, food pantry lines, etc. However, like most everything in public health, the health benefits were invisible. It’s hard to show the impact of infections and deaths that never occurred.

A VERY recent scientific study showed how the U.S. policies (and in other countries) impacted COVID19 spread. And, more interestingly, WHICH policies were most effective and which policies had NO impact on disease spread.

This figure comes directly from the preprint of the Nature article. See below for proper reference. In short, any horizontal line that does NOT cross the vertical line had an impact. So social distancing, quarantining, and working from home all WORKED. However, any horizontal line that DOES cross the vertical line had NO impact. So, for example, schools closing did not have an impact on COVID19 spread in the US.

Translation: Our sacrifices are/were worth it in regards to slowing down COVID19. Specifically, by social distancing, quarantining, and working from home, we were able to prevent 4.8 million diagnosed cases and 60 million actual cases. For the next wave or next pandemic, we can use this information to shut down more effectively.

Love, your local epidemiologist

Source: This was a peer reviewed article published in Nature, which can be found here: https://www.nature.com/arti…/s41586-020-2404-8_reference.pdf. The full reference is… Hsiang et al., (2020) The effect of large-scale anti-contagion policies on the COVID19-pandemic. Nature. https://doi.org/10.1038/s41586-020-2404-8